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Martelli D, Rahman MM, Gurbuz SZ. Validation of a micro-doppler radar for measuring gait modifications during multidirectional visual perturbations. Gait Posture 2024; 113:504-511. [PMID: 39173440 DOI: 10.1016/j.gaitpost.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 06/12/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Changes in spatio-temporal gait parameters and their variability during balance-challenging tasks are markers of motor performance linked to fall risk. Radio frequency (RF) sensors hold great promise towards achieving continuous remote monitoring of these parameters. RESEARCH QUESTIONS To establish the concurrent validity of RF-based gait metrics extracted using micro-Doppler (µD) signatures and to determine whether these metrics are sensitive to gait modifications created by multidirectional visual perturbations. METHODS Fifteen participants walked overground in a virtual environment (VE) and VE with medio-lateral (ML) and antero-posterior (AP) perturbations. An optoelectronic motion capture system and one RF sensor were used to extract the linear velocity of the trunk and estimate step time (ST), step velocity (SV), step length (SL), and their variability (STV, SVV, and SLV). Intra-class coefficient for consistency (ICC), mean and standard deviation of the differences (MD), 95 % limits of agreement, and Pearson correlation coefficients (r) were used to determine concurrent validity. One-way repeated-measures analysis of variance was used to analyze the main and interaction effects of visual conditions. RESULTS All outcomes showed good to excellent reliability (r>0.795, ICC>0.886). Average gait parameters showed good to excellent agreement, with values obtained with the RF sensor systematically smaller than the values obtained with the markers (MD of 0.001 s, 0.09 m/s, and 0.06 m). Gait variability parameters showed poor to moderate agreement, with values obtained with the RF sensor systematically larger than those obtained with the markers (MD of 1.9 %-3.9 %). Both measurement systems reported decreased SL and SV during ML perturbations, but the gait variability parameters extracted with the radar were not able to detect the higher STV and SLV during this condition. SIGNIFICANCE The radar µD signature is a valid and reliable method for the assessment of average spatio-temporal gait parameters but gait variability measures need to be viewed with caution because of the lower levels of agreement and sensitivity to ML visual perturbations. This work represents an initial investigation for the development of a low-cost system that will facilitate aging-in-place by providing remote monitoring of gait in natural settings.
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Affiliation(s)
- Dario Martelli
- Department of Orthopedics and Sports Medicine, Medstar Health Research Institute, Baltimore, MD, United States.
| | - M Mahbubur Rahman
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, United States.
| | - Sevgi Z Gurbuz
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, United States.
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Riedel N, Herzog M, Stein T, Deml B. Cognitive-motor interference during walking with modified leg mechanics: a dual-task walking study. Front Psychol 2024; 15:1375029. [PMID: 38699569 PMCID: PMC11063364 DOI: 10.3389/fpsyg.2024.1375029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Background The use of mobile exoskeletons as assistive walking devices has the potential to affect the biomechanics of the musculoskeletal system due to their weight and restricted range of motion. This may result in physical and cognitive load for the user. Understanding how lower extremity loading affects cognitive-motor interference is crucial for the design of wearable devices, including powered exoskeletons, and the development of effective training interventions. Objective This study aims to examine the effects of modified leg mechanics on cognitive-motor interference in dual-task walking. Gait variability, as an indicator of motor control, was analyzed to investigate its relation to cognitive task difficulty and to determine whether lower extremity loading modifies this relationship. Additionally, the impact on the gait pattern, as represented by the mean values of spatio-temporal gait parameters were investigated. Method Fifteen healthy young adults walked on a treadmill with and without weight cuffs bilaterally attached to their thighs and shanks while performing a visual-verbal Stroop test (simple task) and a serial subtraction task (difficult task). Dependent variables include mean values and variability (coefficients of variation) of step length, step width, stride time and double support time. Additionally, secondary task performance as correct response rates and perceived workload were assessed. Results Double support time variability decreased during dual-task walking, but not during walking with modified leg mechanics while performing the difficult secondary task. Walking with modified leg mechanics resulted in increased gait variability compared to normal walking, regardless of cognitive load. During walking with modified leg mechanics, step length, step width, and stride time increased, while double support time decreased. The secondary tasks did not affect the gait pattern. Conclusion The interplay between an external focus of attention and competition for attentional resources may influence the variability of double support time. The findings suggest that walking with modified leg mechanics could increase cognitive-motor interference for healthy young adults in demanding dual-task situations. Therefore, it is important to analyze the underlying mechanisms of cognitive-motor interference in the context of human-exoskeleton interaction.
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Affiliation(s)
- Norman Riedel
- Institute of Human and Industrial Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Michael Herzog
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Barbara Deml
- Institute of Human and Industrial Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
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He M, Lian T, Guo P, Zhang Y, Huang Y, Qi J, Li J, Guan H, Luo D, Liu Z, Zhang W, Zheng Z, Yue H, Li J, Zhang W, Wang R, Zhang F, Wang X, Zhang W. Association between nutritional status and gait performance in Alzheimer's disease. CNS Neurosci Ther 2024; 30:e14502. [PMID: 37950363 PMCID: PMC11017406 DOI: 10.1111/cns.14502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS This study aimed to comprehensively explore the nutrition and gait of AD patients at different stages and the relationship between them. METHODS A total of 85 AD patients were consecutively enrolled in this cross-sectional study and divided into the mild cognitive impairment (MCI) due to AD (AD-MCI) and the dementia due to AD (AD-D) groups. Demographic information, nutritional status, and gait performance were compared between the two groups, and the correlation between nutritional status and gait performance was subsequently analyzed by Pearson and Spearman correlation analyses. RESULTS The AD-D group had lower scores on Mini-Nutritional Assessment (MNA) and MNAm scales, lower levels of urea nitrogen, folic acid, and vitamin B12 in blood, and higher homocysteine level than those in the AD-MCI group (all p < 0.05). The AD-D group had slower step speed, shorter step length, and shorter stride length than those in the AD-MCI group (all p < 0.05). AD patients with decreased scores of MNA and MNAm scales, and declined levels of urea nitrogen and vitamin B12 in blood had reduced gait speed and gait cadence, and prolonged step length time and stride length time, whereas homocysteine showed the almost opposite results (all p < 0.05). In the AD-MCI group, the score of scale was negatively correlated with the coefficient of variation (CV) of stride length, and the folic acid level was negatively correlated with the CV of stride length and cadence (all p < 0.05). CONCLUSIONS AD patients at the dementia stage had worse nutritional status and gait performance than those at the MCI stage, which was associated with worse global cognition and activities of daily living. Poorer nutritional status was associated with higher gait variability in patients at the MCI stage and with poorer gait performance in patients at the dementia stage. Early identification and intervention of patients with nutritional risk or malnutrition may improve gait performance, thus reducing the risk of falling and cognitive decline, as well as the mortality.
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Grants
- 2016YFC1306000 National Key Research and Development Program of China
- 2016YFC1306300 National Key Research and Development Program of China
- 82201639 National Natural Science Foundation of China
- 30770745 National Natural Science Foundation of China
- 81071015 National Natural Science Foundation of China
- 81571229 National Natural Science Foundation of China
- 81970992 National Natural Science Foundation of China
- 2022-2-2048 Capital's Funds for Health Improvement and Research (CFH)
- kz201610025030 Key Technology R&D Program of Beijing Municipal Education Commission
- 4161004 Key Project of Natural Science Foundation of Beijing, China
- 7082032 Natural Science Foundation of Beijing, China
- JJ2018-48 Project of Scientific and Technological Development of Traditional Chinese Medicine in Beijing
- Z121107001012161 Capital Clinical Characteristic Application Research
- 2009-3-26 High Level Technical Personnel Training Project of Beijing Health System, China
- BIBD-PXM2013_014226_07_000084 Project of Beijing Institute for Brain Disorders
- 20071D0300400076 Excellent Personnel Training Project of Beijing, China
- IDHT20140514 Project of Construction of Innovative Teams and Teacher Career Development for Universities and Colleges Under Beijing Municipality
- JING-15-2 Beijing Healthcare Research Project, China
- 14JL15 Capital Medical University, China
- 10JL49 Capital Medical University, China
- 2015-JL-PT-X04 Capital Medical University, China
- PYZ2018077 Natural Science Foundation of Capital Medical University, Beijing, China
- National Key Research and Development Program of China
- National Natural Science Foundation of China
- Capital's Funds for Health Improvement and Research (CFH)
- Natural Science Foundation of Beijing, China
- Capital Medical University, China
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Affiliation(s)
- Mingyue He
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Tenghong Lian
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Peng Guo
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yanan Zhang
- Department of Blood Transfusion, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yue Huang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine & HealthUNSW SydneySydneyNew South WalesAustralia
| | - Jing Qi
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Jinghui Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Huiying Guan
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Dongmei Luo
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zhan Liu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Weijia Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zijing Zheng
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Hao Yue
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Jing Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Wenjing Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Ruidan Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Fan Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xiaomin Wang
- Department of PhysiologyCapital Medical UniversityBeijingChina
| | - Wei Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Center of Parkinson's DiseaseBeijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory on Parkinson DiseaseBeijingChina
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Latour E, Latour EE, Arlet J. Regional differences in the biological variability of plantar pressure as a basis for refining diagnostic gait analysis. Sci Rep 2024; 14:5911. [PMID: 38467651 PMCID: PMC10928083 DOI: 10.1038/s41598-024-53787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
The variability of movement plays a crucial role in shaping individual's gait pattern and could, therefore, potentially serve diagnostic purposes. Nevertheless, existing concepts for the use of variability in diagnosing gait present a challenge due to the lack of adequate benchmarks and methods for comparison. We assessed the individuality of contribution of foot parts that directly mediate the transmission of forces between the foot and the ground in body weight shifting during walking based on 200 pedobarometric measurements corresponding to the analysed foot parts for each of 19 individuals in a homogeneous study group. Our results show a degree of individualisation of the contribution of particular foot parts in the weight-shift high enough to justify the need to consider it in the diagnostic analysis. Furthermore they reveal noticeable, functionally driven differences between plantar areas most apparent between the lowest individuality for the first foot ray and the highest for second one and metatarsus. The diagnostic reference standard in pedobarometry should describe the contribution in the shift of body weight during walking for each area of the foot separately and include information on the intra-individual variation and individualisation of descriptors of the contribution. Such a comprehensive standard has the potential to increase the diagnostic value of pedobarometry through enrichment of the assessment description.
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Affiliation(s)
- Ewa Latour
- Department of Physiotherapy, Poznan University of Physical Education, 61-871, Poznań, Poland.
| | - Emilia E Latour
- Department of Physiotherapy, Poznan University of Physical Education, 61-871, Poznań, Poland
| | - Jarosław Arlet
- Department of Physiotherapy, Poznan University of Physical Education, 61-871, Poznań, Poland
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Madrid J, Benning L, Selig M, Ulrich B, Jolles BM, Favre J, Benninger DH. Slowing gait during turning: how volition of modifying walking speed affects the gait pattern in healthy adults. Front Hum Neurosci 2024; 18:1269772. [PMID: 38524921 PMCID: PMC10959554 DOI: 10.3389/fnhum.2024.1269772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/09/2024] [Indexed: 03/26/2024] Open
Abstract
Background Turning during walking and volitionally modulating walking speed introduces complexity to gait and has been minimally explored. Research question How do the spatiotemporal parameters vary between young adults walking at a normal speed and a slower speed while making 90°, 180°, and 360° turns? Methods In a laboratory setting, the spatiotemporal parameters of 10 young adults were documented as they made turns at 90°, 180°, and 360°. A generalized linear model was utilized to determine the effect of both walking speed and turning amplitude. Results Young adults volitionally reducing their walking speed while turning at different turning amplitudes significantly decreased their cadence and spatial parameters while increasing their temporal parameters. In conditions of slower movement, the variability of certain spatial parameters decreased, while the variability of some temporal parameters increased. Significance This research broadens the understanding of turning biomechanics in relation to volitionally reducing walking speed. Cadence might be a pace gait constant synchronizing the rhythmic integration of several inputs to coordinate an ordered gait pattern output. Volition might up-regulate or down-regulate this pace gait constant (i.e., cadence) which creates the feeling of modulating walking speed.
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Affiliation(s)
- Julian Madrid
- Department of Clinical Neurosciences (DNC), Clinic of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mischa Selig
- Department of Orthopedics and Trauma Surgery, G.E.R.N. Research Center for Tissue Replacement, Regeneration and Neogenesis, Freiburg, Germany
| | - Baptiste Ulrich
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine (DAL), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine (DAL), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine (DAL), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - David H. Benninger
- Department of Clinical Neurosciences (DNC), Clinic of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
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6
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Xie H, Xia C, Zhao H, Xia Z, Zhang N, Huang Y. Variability, asymmetry, and bilateral coordination of gait during single- and dual-task walking of patients with cerebral small vessel disease. Int J Neurosci 2024:1-15. [PMID: 38294519 DOI: 10.1080/00207454.2024.2309454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE We investigated coefficient of variation (CV), gait asymmetry (GA) and phase coordination index (PCI) in CSVD (cerebral small vessel disease) patients during STW (single task walking) and DTW (dual task walking) and explored the relationship between above parameters with disease severity and cognitive function. METHODS This cross-sectional study collected cognitive function indices and gait parameters from 23 healthy controls and 94 patients with CSVD during STW and DTW. According to the Fazekas scales, the severity of CSVD valued by white matter hyperintensity (WMH) were divided into control, mild, moderate, severe and control group. MRIs were analyzed for WMHs, CMB, lacunes, etc. RESULTS The control group showed lower PCI than CSVD patients during STW; no differences were detected among the disease severity groups. During DTW, all four groups exhibited significant differences in PCI and CV. For the moderate and severe groups, coordination and variation significantly differed between the two walking methods. There were correlations between the PCI and GA in the moderate and severe groups (R = 0.376, R = 0.573 during DTW; R = 0.414, R = 0.643 during STW), and no correlations in the control group and mild CSVD group. Conclusion: PCI and CV may be vital for detecting the symptoms in the early stage of CSVD disease. We also verified that the PCI could become the bridge across the cognition and motor disorder in CSVD, which was helpful for evaluating clinical symptoms comprehensively.
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Affiliation(s)
- Hongyang Xie
- Department of Neurology, Chinese PLA General Hospital, 5 nanmencang Hutong, Dongsishitiao, Dongcheng District, Beijing, China
| | - Cuiqiao Xia
- Department of Neurology, Chinese PLA General Hospital, 5 nanmencang Hutong, Dongsishitiao, Dongcheng District, Beijing, China
| | - Hongyi Zhao
- Department of Neurology, Chinese PLA General Hospital, 5 nanmencang Hutong, Dongsishitiao, Dongcheng District, Beijing, China
- Department of Neurology, Number 984 Hospital of the PLA, 116 zaojiatun village, Shangzhuang Town, Haidian District, Beijing, China
| | - Zhenxi Xia
- Department of Neurology, Chinese PLA General Hospital, 5 nanmencang Hutong, Dongsishitiao, Dongcheng District, Beijing, China
| | - Nan Zhang
- Department of Neurology, Chinese PLA General Hospital, 5 nanmencang Hutong, Dongsishitiao, Dongcheng District, Beijing, China
| | - Yonghua Huang
- Department of Neurology, Chinese PLA General Hospital, 5 nanmencang Hutong, Dongsishitiao, Dongcheng District, Beijing, China
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Couto AGB, Vaz MAP, Pinho L, Félix J, Moreira J, Pinho F, Mesquita IA, Mesquita Montes A, Crasto C, Sousa ASP. Interlimb Coordination during Double Support Phase of Gait in People with and without Stroke. J Mot Behav 2023; 56:195-210. [PMID: 37990958 DOI: 10.1080/00222895.2023.2282088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
This study aims to identify differences between participants with and without stroke regarding the ipsilesional and contralesional lower limbs kinematics, kinetics, muscle activity and their variability during double support phase of gait. Eleven post-stroke and thirteen healthy participants performed 10 gait trials at a self-selected speed while being monitored by an optoelectronic motion capture system, two force plates and an electromyographic system. The following outcomes were evaluated during the double support: the time and the joint position; the external mechanical work on the centre of mass; and the relative electromyographic activity. Both, contralesional/ipsilesional and dominant/non-dominant of participants with and without stroke, respectively, were evaluated during double support phase of gait in trailing or leading positions. The average value of each parameter and the coefficient of variation of the 10 trials were analysed. Post-stroke participants present bilateral decreased mechanical work on the centre of mass and increased variability, decreased contralesional knee and ankle flexion in trailing position, increased ipsilesional knee flexion in leading position and increased variability. Increased relative muscle activity was observed in post-stroke participants with decreased variability. Mechanical work on the centre of mass seems to be the most relevant parameter to identify interlimb coordination impairments in post-stroke subjects.
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Affiliation(s)
- Ana G B Couto
- Department of Physiotherapy and Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
- Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
| | - Mário A P Vaz
- Institute of Mechanical Engineering and Industrial Management, Faculty of Engineering, University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Liliana Pinho
- Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- College of Health Sciences - Escola Superior de Saúde do Vale do Ave, Cooperative for Higher, Polytechnic and University Education, Vila Nova de Famalicão, Portugal
- Faculty of Sport, University of Porto, Porto, Portugal
| | - José Félix
- Department of Physics and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Juliana Moreira
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Francisco Pinho
- College of Health Sciences - Escola Superior de Saúde do Vale do Ave and Health and Human Movement Unit (H2M), Cooperative for Higher, Polytechnic and University Education, Vila Nova de Famalicão, Portugal
| | - Inês Albuquerque Mesquita
- Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
- Department of Functional Sciences and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - António Mesquita Montes
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
| | - Carlos Crasto
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
| | - Andreia S P Sousa
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
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Visscher RM, Murer J, Fahimi F, Viehweger E, Taylor WR, Brunner R, Singh NB. Identifying treatment non-responders based on pre-treatment gait characteristics - A machine learning approach. Heliyon 2023; 9:e21242. [PMID: 37908707 PMCID: PMC10613900 DOI: 10.1016/j.heliyon.2023.e21242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
Background Paediatric movement disorders such as cerebral palsy often negatively impact walking behaviour. Although clinical gait analysis is usually performed to guide therapy decisions, not all respond positively to their assigned treatment. Identifying these individuals based on their pre-treatment characteristics could guide clinicians towards more appropriate and personalized interventions. Using routinely collected pre-treatment gait and anthropometric features, we aimed to assess whether standard machine learning approaches can be effective in identifying patients at risk of negative treatment outcomes. Methods Observational data of 119 patients with movement disorders were retrospectively extracted from a local clinical database, comprising sagittal joint angles and spatiotemporal parameters, derived from motion capture data pre- and post-treatment (physiotherapy, orthosis, botulin toxin injections, or surgery). Participants were labelled based on their change in gait profile score (GPS, non-responders with a decline in GPS of <1.6° vs. responders). Their pre-treatment features (sagittal joint angles, spatiotemporal parameters, anthropometrics) were used to train a support vector machine classifier with 5-fold cross-validation and Bayesian optimization within a MATLAB-based Classification Learner App. Results An average accuracy of 88.2 ± 0.5 % was achieved for identifying participants whose gait will not respond to treatment, with 64 % true negative rate and an area under the curve of 88 %. Conclusion Overall, a classical machine learning model was able to identify patients at risk of not responding to treatment, based on gait features and anthropometrics collected prior to treatment. The output of such a model could function as a warning signal, notifying clinicians that a certain individual might not respond well to the standard of care and that a more personalized intervention might be needed.
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Affiliation(s)
- Rosa M.S. Visscher
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Science & Technology, ETH Zürich, Zürich, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Julia Murer
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Science & Technology, ETH Zürich, Zürich, Switzerland
| | - Fatemeh Fahimi
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Science & Technology, ETH Zürich, Zürich, Switzerland
- Singapore-ETH Centre, Future Health Technologies Program, CREATE campus, 1 CREATE Way, #06-01 CREATE Tower, Singapore 138602
| | - Elke Viehweger
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - William R. Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Science & Technology, ETH Zürich, Zürich, Switzerland
| | - Reinald Brunner
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Navrag B. Singh
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Science & Technology, ETH Zürich, Zürich, Switzerland
- Singapore-ETH Centre, Future Health Technologies Program, CREATE campus, 1 CREATE Way, #06-01 CREATE Tower, Singapore 138602
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Gregg E, Beggs C, Bissas A, Nicholson G. A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women. PLoS One 2023; 18:e0293729. [PMID: 37906588 PMCID: PMC10617741 DOI: 10.1371/journal.pone.0293729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.
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Affiliation(s)
- Emily Gregg
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Clive Beggs
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Athanassios Bissas
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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10
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Visscher RMS, Gwerder M, Viehweger E, Taylor WR, Brunner R, Singh NB. Can developmental trajectories in gait variability provide prognostic clues in motor adaptation among children with mild cerebral palsy? A retrospective observational cohort study. Front Hum Neurosci 2023; 17:1205969. [PMID: 37795211 PMCID: PMC10546019 DOI: 10.3389/fnhum.2023.1205969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Aim To investigate whether multiple domains of gait variability change during motor maturation and if this change over time could differentiate children with a typical development (TDC) from those with cerebral palsy (CwCP). Methods This cross-sectional retrospective study included 42 TDC and 129 CwCP, of which 99 and 30 exhibited GMFCS level I and II, respectively. Participants underwent barefoot 3D gait analysis. Age and parameters of gait variability (coefficient of variation of stride-time, stride length, single limb support time, walking speed, and cadence; as well as meanSD for hip flexion, knee flexion, and ankle dorsiflexion) were used to fit linear models, where the slope of the models could differ between groups to test the hypotheses. Results Motor-developmental trajectories of gait variability were able to distinguish between TDC and CwCP for all parameters, except the variability of joint angles. CwCP with GMFCS II also showed significantly higher levels of gait variability compared to those with GMFCS I, these levels were maintained across different ages. Interpretation This study showed the potential of gait variability to identify and detect the motor characteristics of high functioning CwCP. In future, such trajectories could provide functional biomarkers for identifying children with mild movement related disorders and support the management of expectations.
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Affiliation(s)
- Rosa M. S. Visscher
- Department of Health Science & Technology, Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Michelle Gwerder
- Department of Health Science & Technology, Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Elke Viehweger
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - William R. Taylor
- Department of Health Science & Technology, Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Singapore-ETH Centre, Future Health Technologies Program, CREATE Campus, Singapore, Singapore
| | - Reinald Brunner
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Navrag B. Singh
- Department of Health Science & Technology, Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Singapore-ETH Centre, Future Health Technologies Program, CREATE Campus, Singapore, Singapore
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11
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Leong S, Teh BM, Duong T, Hu D, Chui A, Chen JS, Sisti MB, Wang TJ, Zanotto D, Lalwani AK. Instrumented insoles for assessment of gait in patients with vestibular schwannoma. WEARABLE TECHNOLOGIES 2023; 4:e14. [PMID: 38487773 PMCID: PMC10936291 DOI: 10.1017/wtc.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 03/17/2024]
Abstract
Background Imbalance and gait disturbances are common in patients with vestibular schwannoma (VS) and can result in significant morbidity. Current methods for quantitative gait analysis are cumbersome and difficult to implement. Here, we use custom-engineered instrumented insoles to evaluate the gait of patients diagnosed with VS. Methods Twenty patients with VS were recruited from otology, neurosurgery, and radiation oncology clinics at a tertiary referral center. Functional gait assessment (FGA), 2-minute walk test (2MWT), and uneven surface walk test (USWT) were performed. Custom-engineered instrumented insoles, equipped with an 8-cell force sensitive resistor (FSR) and a 9-degree-of-freedom inertial measurement unit (IMU), were used to collect stride-by-stride spatiotemporal gait parameters, from which mean values and coefficients of variation (CV) were determined for each patient. Results FGA scores were significantly correlated with gait metrics obtained from the 2MWT and USWT, including stride length, stride velocity, normalized stride length, normalized stride velocity, stride length CV, and stride velocity CV. Tumor diameter was negatively associated with stride time and swing time on the 2MWT; no such association existed between tumor diameter and FGA or DHI. Conclusions Instrumented insoles may unveil associations between VS tumor size and gait dysfunction that cannot be captured by standardized clinical assessments and self-reported questionnaires.
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Affiliation(s)
- Stephen Leong
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Bing M. Teh
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Otolaryngology—Head & Neck Surgery, Monash Health; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VC, Australia
| | - Ton Duong
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Diane Hu
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander Chui
- Department of Biological Sciences, Columbia University, New York, NY, USA
| | - Jocelyn S. Chen
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Michael B. Sisti
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurological Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiation Oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Tony J.C. Wang
- Department of Neurological Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiation Oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Damiano Zanotto
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Anil K. Lalwani
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
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12
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Olsen S, Rashid U, Allerby C, Brown E, Leyser M, McDonnell G, Alder G, Barbado D, Shaikh N, Lord S, Niazi IK, Taylor D. Smartphone-based gait and balance accelerometry is sensitive to age and correlates with clinical and kinematic data. Gait Posture 2023; 100:57-64. [PMID: 36481647 DOI: 10.1016/j.gaitpost.2022.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Gait&Balance (G&B) App has produced valid and reliable measures of gait and balance in young healthy adults but has not been tested in older adults. RESEARCH QUESTION In healthy middle-to-older aged adults, are G&B App measurements sensitive to age, valid against clinical and kinematic measures, and reliable? METHOD Healthy participants (n = 34, 14 male, 42-94 years) completed the G&B App protocol three times within a single session. 3D kinematics were collected concurrently. Clinical balance measures were collected (Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), Mini Balance Evaluation Systems Test (MBT), and Functional Gait Assessment (FGA)). Sensitivity to age was assessed with Pearson's correlations. Validity tests included Pearson's correlations and Bland-Altman limits of agreement. Reliability tests included intra-class correlation coefficients and standard error of the measure. RESULTS During quiet stance on a compliant surface, the G&B App was sensitive to age-related differences not detectable with the mCTSIB. During walking tasks, there was adequate convergent validity between the MBT and G&B App measures of step length, and between the FGA and G&B App measures of walking speed, step length, and periodicity. The G&B App had moderate-to-excellent validity against 3D kinematics for postural stability during quiet stance (r 0.98 [0.98, 0.99]), step time (r 0.97 [0.96, 0.98]), walking speed (r 0.79 [0.7, 0.86]), and step length (r 0.73 [0.61, 0.81]). Test-retest reliability was moderate-to-excellent for G&B App measures of postural stability, walking speed, periodicity, step length, and step time. G&B App measures of step length asymmetry, step length variability, step time asymmetry, and step time variability had poor validity and reliability. SIGNIFICANCE The G&B App was sensitive to age-related differences in balance not detectable with clinical measurement. It provides valid and reliable measures of postural stability, step length, step time, and periodicity, which are not currently available in standard practice.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand
| | - Celia Allerby
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Eliza Brown
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Michaela Leyser
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gabrielle McDonnell
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - David Barbado
- Department of Sport Science, Sports Research Centre, Miguel Hernandez University of Elche, Avda. de la Universidad s/n, Elche 03202, Spain; Institute for Health and Biomedical Research (ISABIAL Foundation), Avda. Pintor Baeza, 12 HGUA, Alicante 03550, Spain
| | - Nusratnaaz Shaikh
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Sue Lord
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand; Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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13
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Lindh-Rengifo M, Jonasson SB, Ullén S, Palmqvist S, van Westen D, Stomrud E, Mattsson-Carlgren N, Nilsson MH, Hansson O. Effects of Brain Pathologies on Spatiotemporal Gait Parameters in Patients with Mild Cognitive Impairment. J Alzheimers Dis 2023; 96:161-171. [PMID: 37742636 PMCID: PMC10657715 DOI: 10.3233/jad-221303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Impaired gait can precede dementia. The associations between gait parameters and brain pathologies are therefore of interest. OBJECTIVE To explore how different brain pathologies (i.e., vascular and Alzheimer's) are associated with specific gait parameters from various gait components in persons with mild cognitive impairment (MCI), who have an increased risk of developing dementia. METHODS This cross-sectional study included 96 patients with MCI (mean 72, ±7.5 years; 52% women). Gait was evaluated by using an electronic walkway, GAITRite®. Four gait parameters (step velocity variability; step length; step time; stance time asymmetry) were used as dependent variables in multivariable linear regression analyses. Independent variables included Alzheimer's disease pathologies (amyloid-β and tau) by using PET imaging and white matter hyperintensities (WMH) by using MRI. Covariates included age, sex, comorbidities (and intracranial volume in analyses that includedWMH). RESULTS Increased tau-PET (Braak I-IV region of interest [ROI]) was associated with step velocity variability (standardized regression coefficient, β= 0.383, p < 0.001) and step length (β= 0.336, p < 0.001), which remained significant when using different Braak ROIs (I-II, III-IV, V-VI). The associations remained significant when adjusting for WMH (p < 0.001). When also controlling for gait speed, tau was no longer significantly (p = 0.168) associated with an increased step length. No significant associations between gait and Aβ-PET load or WMH were identified. CONCLUSIONS The results indicate that one should pay specific attention to assess step velocity variability when targeting single task gait in patients with MCI. Future studies should address additional gait variability measures and dual tasking in larger cohorts.
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Affiliation(s)
- Magnus Lindh-Rengifo
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Susann Ullén
- Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Sweden
| | - Sebastian Palmqvist
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
- Image and Function, Skåne University Hospital, Lund, Sweden
| | - Erik Stomrud
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Maria H. Nilsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Oskar Hansson
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
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14
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Madrid J, Ulrich B, Santos AN, Jolles BM, Favre J, Benninger DH. Spatiotemporal parameters during turning gait maneuvers of different amplitudes in young and elderly healthy adults: A descriptive and comparative study. Gait Posture 2023; 99:152-159. [PMID: 36446222 DOI: 10.1016/j.gaitpost.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/09/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Turning during walking adds complexity to gait and has been little investigated until now. Research question What are the differences in spatiotemporal parameters between young and elderly healthy adults performing quarter-turns (90°), half-turns (180°) and full-turns (360°)? METHODS The spatiotemporal parameters of 10 young and 10 elderly adults were recorded in a laboratory while turning at 90°, 180° and 360°. Two-way mixed ANOVA were performed to determine the effect of age and turning amplitude. RESULTS Elderly were slower and needed more steps and time to perform turns of larger amplitude than young adults. Cadence did not differ across age or across turning amplitude. Generally, in the elderly, the spatial parameters were smaller and the temporal parameters enhancing stability (i.e., double-support phase and stance/cycle ratio) were larger, especially for turns of larger amplitudes. In elderly adults, the variability of some spatial parameters was decreased, whereas the variability of some temporal parameters was increased. Stride width of the external leg showed the most substantial difference between groups. Most parameters differed between turning at 90° and turning at larger amplitudes (180°, 360°). Significance This study extends the characterization of turning biomechanics with respect to ageing. It also suggested paying particular attention to the turning amplitude. Finally, the age-related differences may pave the way for new selective rehabilitation protocols in the elderly.
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Affiliation(s)
- Julian Madrid
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Clinical Neurosciences (DNC), Clinic of Neurology, Lausanne, Switzerland.
| | - Baptiste Ulrich
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland
| | - Alejandro N Santos
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Clinical Neurosciences (DNC), Clinic of Neurology, Lausanne, Switzerland
| | - Brigitte M Jolles
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
| | - Julien Favre
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland
| | - David H Benninger
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Clinical Neurosciences (DNC), Clinic of Neurology, Lausanne, Switzerland.
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15
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Peterka RJ, Gruber-Fox A, Heeke PK. Asymmetry measures for quantification of mechanisms contributing to dynamic stability during stepping-in-place gait. Front Neurol 2023; 14:1145283. [PMID: 37153656 PMCID: PMC10157157 DOI: 10.3389/fneur.2023.1145283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023] Open
Abstract
The goal of this study is to introduce and to motivate the use of new quantitative methods to improve our understanding of mechanisms that contribute to the control of dynamic balance during gait. Dynamic balance refers to the ability to maintain a continuous, oscillating center-of-mass (CoM) motion of the body during gait even though the CoM frequently moves outside of the base of support. We focus on dynamic balance control in the frontal plane or medial-lateral (ML) direction because it is known that active, neurally-mediated control mechanisms are necessary to maintain ML stability. Mechanisms that regulate foot placement on each step and that generate corrective ankle torque during the stance phase of gait are both known to contribute to the generation of corrective actions that contribute to ML stability. Less appreciated is the potential role played by adjustments in step timing when the duration of the stance and/or swing phases of gait can be shortened or lengthened to allow torque due to gravity to act on the body CoM over a shorter or longer time to generate corrective actions. We introduce and define four asymmetry measures that provide normalized indications of the contribution of these different mechanisms to gait stability. These measures are 'step width asymmetry', 'ankle torque asymmetry', 'stance duration asymmetry', and 'swing duration asymmetry'. Asymmetry values are calculated by comparing corresponding biomechanical or temporal gait parameters from adjacent steps. A time of occurrence is assigned to each asymmetry value. An indication that a mechanism is contributing to ML control is obtained by comparing asymmetry values to the ML body motion (CoM angular position and velocity) at the time points associated with the asymmetry measures. Example results are demonstrated with measures obtained during a stepping-in-place (SiP) gait performed on a stance surface that either remained fixed and level or was pseudorandomly tilted to disturb balance in the ML direction. We also demonstrate that the variability of asymmetry measures obtained from 40 individuals during unperturbed, self-paced SiP were highly correlated with corresponding coefficient of variation measures that have previously been shown to be associated with poor balance and fall risk.
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Affiliation(s)
- Robert J. Peterka
- Department of Veterans Affairs, National Center for Rehabilitative Auditory Research, Portland, OR, United States
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- *Correspondence: Robert J. Peterka,
| | - Apollonia Gruber-Fox
- Department of Veterans Affairs, National Center for Rehabilitative Auditory Research, Portland, OR, United States
| | - Paige K. Heeke
- Department of Veterans Affairs, National Center for Rehabilitative Auditory Research, Portland, OR, United States
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16
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Chan LLY, Choi TCM, Lord SR, Brodie MA. Development and large-scale validation of the Watch Walk wrist-worn digital gait biomarkers. Sci Rep 2022; 12:16211. [PMID: 36217013 PMCID: PMC9551062 DOI: 10.1038/s41598-022-20327-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Digital gait biomarkers (including walking speed) indicate functional decline and predict hospitalization and mortality. However, waist or lower-limb devices often used are not designed for continuous life-long use. While wrist devices are ubiquitous and many large research repositories include wrist-sensor data, widely accepted and validated digital gait biomarkers derived from wrist-worn accelerometers are not available yet. Here we describe the development of advanced signal processing algorithms that extract digital gait biomarkers from wrist-worn devices and validation using 1-week data from 78,822 UK Biobank participants. Our gait biomarkers demonstrate good test-retest-reliability, strong agreement with electronic walkway measurements of gait speed and self-reported pace and significantly discriminate individuals with poor self-reported health. With the almost universal uptake of smart-watches, our algorithms offer a new approach to remotely monitor life-long population level walking speed, quality, quantity and distribution, evaluate disease progression, predict risk of adverse events and provide digital gait endpoints for clinical trials.
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Affiliation(s)
- Lloyd L Y Chan
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, 139 Baker Street, Randwick, NSW, 2031, Australia.,School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Tiffany C M Choi
- School of Health Sciences, Caritas Institute of Higher Education, 2 Chui Ling Lane, New Territories, Tseung Kwan O, Hong Kong, China
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, 139 Baker Street, Randwick, NSW, 2031, Australia. .,School of Population Health, University of New South Wales, Kensington, NSW, Australia.
| | - Matthew A Brodie
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, 139 Baker Street, Randwick, NSW, 2031, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Samuels Building (F25), Kensington Campus, Kensington, Sydney, NSW, 2052, Australia
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17
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Braun T, Wiegard A, Geritz J, Hansen C, Tan KE, Hildesheim H, Kudelka J, Maetzler C, Welzel J, Romijnders R, Maetzler W, Bergmann P. Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors. J Geriatr Cardiol 2022; 19:660-674. [PMID: 36284678 PMCID: PMC9548060 DOI: 10.11909/j.issn.1671-5411.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF. METHODS For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models. RESULTS The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19). CONCLUSIONS This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- HSD Hochschule Döpfer (University of Applied Sciences), Waidmarkt 3 und 9, 50676 Cologne, Germany
| | - Anna Wiegard
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Kim Eng Tan
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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18
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Gaßner H, Trutt E, Seifferth S, Friedrich J, Zucker D, Salhani Z, Adler W, Winkler J, Jost WH. Treadmill training and physiotherapy similarly improve dual task gait performance: a randomized-controlled trial in Parkinson's disease. J Neural Transm (Vienna) 2022; 129:1189-1200. [PMID: 35697942 PMCID: PMC9463305 DOI: 10.1007/s00702-022-02514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022]
Abstract
Motor-cognitive dual tasks are used to investigate the interplay between gait and cognition. Dual task walking in patients with Parkinson's disease (PD) results in decreased gait speed and more importantly in an increased fall risk. There is evidence that physical training may improve gait during dual task challenge. Physiotherapy and treadmill walking are known to improve single task gait. The aim of this study was to investigate the impact of individualized physiotherapy or treadmill training on gait during dual task performance. 105 PD patients were randomly assigned to an intervention group (physiotherapy or treadmill). Both groups received 10 individual interventional sessions of 25 min each and additional group therapy sessions for 14 days. Primary outcome measure was the dual task gait speed. Secondary outcomes were additional gait parameters during dual task walking, UPDRS-III, BBS and walking capacity. All gait parameters were recorded using sensor-based gait analysis. Gait speed improved significantly by 4.2% (treadmill) and 8.3% (physiotherapy). Almost all secondary gait parameters, UPDRS-III, BBS, and walking capacity improved significantly and similarly in both groups. However, interaction effects were not observed. Both interventions significantly improved gait in patients with mild to moderate PD. However, treadmill walking did not show significant benefits compared to individualized physiotherapy. Our data suggest that both interventions improve dual task walking and therefore support safe and independent walking. This result may lead to more tailored therapeutic preferences.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
- Fraunhofer IIS, Fraunhofer Institute for Integrated Circuits IIS, Am Wolfsmantel 33, 91058, Erlangen, Germany.
| | | | - Sarah Seifferth
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Jana Friedrich
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | | | | | - Werner Adler
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Zucchelli A, Pancera S, Bianchi LNC, Marengoni A, Lopomo NF. Technologies for the Instrumental Evaluation of Physical Function in Persons Affected by Chronic Obstructive Pulmonary Disease: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176620. [PMID: 36081078 PMCID: PMC9459845 DOI: 10.3390/s22176620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 05/17/2023]
Abstract
Several systems, sensors, and devices are now available for the instrumental evaluation of physical function in persons with Chronic Obstructive Pulmonary Disease (COPD). We aimed to systematically review the literature about such technologies. The literature search was conducted in all major scientific databases, including articles published between January 2001 and April 2022. Studies reporting measures derived from the instrumental assessment of physical function in individuals with COPD were included and were divided into application and validation studies. The quality of validation studies was assessed with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias tool. From 8752 articles retrieved, 21 application and 4 validation studies were included in the systematic review. Most application studies employed accelerometers, gait analysis systems, instrumented mattresses, or force plates to evaluate walking. Surface electro-myography or near-infrared spectroscopy were employed in four studies. Validation studies were heterogeneous and presented a risk of bias ranging from inadequate to doubtful. A variety of data regarding physical function can be retrieved from technologies used in COPD studies. However, a general lack of standardization and limitations in study design and sample size hinder the implementation of the instrumental evaluation of function in clinical practice.
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Affiliation(s)
- Alberto Zucchelli
- Department of Information Engineering, Università degli Studi di Brescia, Brescia 25123, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna SE-171 65, Sweden
| | - Simone Pancera
- IRCCS Fondazione Don Carlo Gnocchi, Milan 20148, Italy
- Correspondence: (S.P.); (N.F.L.); Tel.: +39-030-29881 (S.P. & N.F.L.)
| | | | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna SE-171 65, Sweden
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia 25123, Italy
| | - Nicola Francesco Lopomo
- Department of Information Engineering, Università degli Studi di Brescia, Brescia 25123, Italy
- Correspondence: (S.P.); (N.F.L.); Tel.: +39-030-29881 (S.P. & N.F.L.)
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20
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Tobar Montilla CD, Rengifo Rodas CF, Muñoz Añasco M. Petri net transition times as training features for multiclass models to support the detection of neurodegenerative diseases. Biomed Phys Eng Express 2022; 8. [PMID: 36007476 DOI: 10.1088/2057-1976/ac8c9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022]
Abstract
This paper proposes the transition times of Petri net models of human gait as training features for multiclass random forests (RFs) and classification trees (CTs). These models are designed to support screening for neurodegenerative diseases. The proposed Petri net describes gait in terms of nine cyclic phases and the timing of the nine events that mark the transition between phases. Since the transition times between strides vary, each is represented as a random variable characterized by its mean and standard deviation. These transition times are calculated using the PhysioNet database of vertical ground reaction forces (VGRFs) generated by feet-ground contact. This database comprises the VGRFs of four groups: amyotrophic lateral sclerosis, the control group, Huntington's disease, and Parkinson disease. The RF produced an overall classification accuracy of 91%, and the specificities and sensitivities for each class were between 80% and 100%. However, despite this high performance, the RF-generated models demonstrated lack of interpretability prompted the training of a CT using identical features. The obtained tree comprised only four features and required a maximum of three comparisons. However, this simplification dramatically reduced the overall accuracy from 90.6% to 62.3%. The proposed set features were compared with those included in PhysioNet database of VGRFs. In terms of both the RF and CT, more accurate models were established using our features than those of the PhysioNet.
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Affiliation(s)
| | - Carlos Felipe Rengifo Rodas
- Electronics, Instrumentation and Control, Universidad del Cauca, Calle 5 No. 4-70, Sector Tulcan, Oficina 430, Popayan, Popayan, Departamento del Cauca, 190001, COLOMBIA
| | - Mariela Muñoz Añasco
- Universidad del Cauca, Calle 5 No 4 - 70 Sector Tulcan, Oficina 430, Popayan, Popayan, 190001, COLOMBIA
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21
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Effects of age on dynamic balance measures and their correlation during walking across the adult lifespan. Sci Rep 2022; 12:14301. [PMID: 35995982 PMCID: PMC9395363 DOI: 10.1038/s41598-022-18382-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
In this study, we aimed to discover (1) the effects of age on dynamic balance measures, including the margin of stability (MOS), whole-body angular momentum (H), and misalignment of the desired and measured centers of pressure (dCOP and mCOP, respectively) in the anteroposterior (AP) and mediolateral (ML) directions, (2) the relationship between gait parameters and these balance measures, and (3) the relationships between these balance measures. We used the kinetic and kinematic data of 151 participants aged 20–77 years from a publicly available database. Participants were divided into three groups: young, middle-aged, and old. The step width of the old group was higher than that of the young group. Age-related differences in dynamic measures were found in the ML direction and not in the AP direction: MOS, peak-to-peak range of H, and dCOP–mCOP in the old group were greater than in the young group. ML MOS positively correlated with the frontal peak-to-peak range of H. The ML peak-to-peak range of H positively correlated with ML dCOP–mCOP across the adult lifespan. Our findings provide new insights for understanding the effects of age on dynamic balance and the relationships between the metrics. Older adults walked with a larger step width, resulting in a large stability margin in the ML direction, although with increased moment and momentum around the center of mass in the frontal plane.
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22
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Overnight unilateral withdrawal of thalamic deep brain stimulation to identify reversibility of gait disturbances. Exp Neurol 2022; 355:114135. [DOI: 10.1016/j.expneurol.2022.114135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022]
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Wearable gait analysis systems: ready to be used by medical practitioners in geriatric wards? Eur Geriatr Med 2022; 13:817-824. [PMID: 35243600 PMCID: PMC9378320 DOI: 10.1007/s41999-022-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/16/2022] [Indexed: 11/06/2022]
Abstract
Aim To investigate the feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system. Findings Wearable gait analysis can be implemented into geriatric wards, showing its readiness for a transformation from a pure research tool to a practically usable gait analysis system. Message Despite good transferability into clinical practice, future research should aim to increase functionality and applicability of wearable gait analysis systems in clinical contexts. Purpose We assess feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system. Methods Gait parameters of 83 patients (83.34 ± 5.88 years, 58/25 female/male) were recorded at admission and/or discharge to/from two geriatric inpatient wards. Gait parameters were tested for statistically significant differences between admission and discharge. Walking distance measured by a wearable gait analysis system was correlated with distance assessed by physiotherapists. Examiners rated usability using the system usability scale. Patients reported acceptability on a five-point Likert-scale. Results The total distance measures highly correlate (r = 0.89). System Usability Scale is above the median threshold of 68, indicating good usability. Majority of patients does not have objections regarding the use of the system. Among other gait parameters, mean heel strike angle changes significantly between admission and discharge. Conclusion Wearable gait analysis system is objectively and subjectively usable in a clinical setting and accepted by patients. It offers a reasonably valid assessment of gait parameters and is a feasible way for instrumented gait analysis.
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Akimoto T, Kawamura K, Wada T, Ishihara N, Yokota A, Suginoshita T, Yokoyama S. Gait cycle time variability in patients with knee osteoarthritis and its possible associating factors. J Phys Ther Sci 2022; 34:140-145. [PMID: 35221518 PMCID: PMC8860692 DOI: 10.1589/jpts.34.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/13/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Knee osteoarthritis can alter gait variability; however, few studies have
investigated the associating factors with gait cycle time variability. The first objective
was to compare gait cycle variability between female patients with knee osteoarthritis and
healthy elderly females and to determine gait characteristics in patients with knee
osteoarthritis. The second objective was to identify the associating factors with gait
cycle time variability. [Participants and Methods] The participants included 24 female
patients diagnosed with knee osteoarthritis and 12 healthy elderly females. Gait cycle
variability (coefficient of variation of gait cycle time), knee extension range of motion,
knee extension strength, 5-m walk test, Timed Up & Go Test, and Western Ontario and
McMaster Universities Osteoarthritis Index were measured. All assessment results were
compared between the knee osteoarthritis and healthy groups. [Results] Gait cycle time
variability was significantly higher in the knee osteoarthritis group than in the healthy
group. Further, it showed a significant positive correlation with the 5-m walk test and
the Western Ontario and McMaster Universities Osteoarthritis Index. [Conclusion] Patients
with knee osteoarthritis presented greater gait cycle variability than that of healthy
individuals. Therefore, rehabilitation to improve gait variability might enhance the
quality of life of patients with knee osteoarthritis.
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Affiliation(s)
- Takeshi Akimoto
- Graduate School of Health Science, Kibi International University: 8 Iga-cho, Takahashi-shi, Okayama 716-8508, Japan.,Department of Orthopedics, Medical Corporation Suginoshita Orthopedic Clinic, Japan
| | - Kenji Kawamura
- Graduate School of Health Science, Kibi International University: 8 Iga-cho, Takahashi-shi, Okayama 716-8508, Japan
| | - Takaaki Wada
- Department of Orthopedics, Medical Corporation Suginoshita Orthopedic Clinic, Japan
| | - Naomichi Ishihara
- Department of Orthopedics, Medical Corporation Suginoshita Orthopedic Clinic, Japan
| | - Akane Yokota
- Department of Orthopedics, Medical Corporation Suginoshita Orthopedic Clinic, Japan
| | - Takehiko Suginoshita
- Department of Orthopedics, Medical Corporation Suginoshita Orthopedic Clinic, Japan
| | - Shigeki Yokoyama
- Graduate School of Health Science, Kyoto Tachibana University, Japan
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25
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Lee Y, Shin S. Improvement of Gait in Patients with Stroke Using Rhythmic Sensory Stimulation: A Case-Control Study. J Clin Med 2022; 11:jcm11020425. [PMID: 35054122 PMCID: PMC8780685 DOI: 10.3390/jcm11020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with stroke suffer from impaired locomotion, exhibiting unstable walking with increased gait variability. Effects of rhythmic sensory stimulation on unstable gait of patients with chronic stroke are unclear. This study aims to determine the effects of rhythmic sensory stimulation on the gait of patients with chronic stroke. Twenty older adults with stroke and twenty age- and gender-matched healthy controls walked 60 m under four conditions: normal walking with no stimulation, walking with rhythmic auditory stimulation (RAS) through an earphone in the ear, walking with rhythmic somatosensory stimulation (RSS) through a haptic device on the wrist of each participant, and walking with rhythmic combined stimulation (RCS: RAS + RSS). Gait performance in the stroke group significantly improved during walking with RAS, RSS, and RCS compared to that during normal walking (p < 0.008). Gait variability significantly decreased under the RAS, RSS, and RCS conditions compared to that during normal walking (p < 0.008). Rhythmic sensory stimulation is effective in improving the gait of patients with chronic stroke, regardless of the type of rhythmic stimuli, compared to healthy controls. The effect was greater in patients with reduced mobility, assessed by the Rivermead Mobility Index (RMI).
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Affiliation(s)
- Yungon Lee
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
| | - Sunghoon Shin
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
- Correspondence: ; Tel.: +82-10-8940-2406
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26
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Shah VV, Rodriguez-Labrada R, Horak FB, McNames J, Casey H, Hansson Floyd K, El-Gohary M, Schmahmann JD, Rosenthal LS, Perlman S, Velázquez-Pérez L, Gomez CM. Gait Variability in Spinocerebellar Ataxia Assessed Using Wearable Inertial Sensors. Mov Disord 2021; 36:2922-2931. [PMID: 34424581 DOI: 10.1002/mds.28740] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Quantitative assessment of severity of ataxia-specific gait impairments from wearable technology could provide sensitive performance outcome measures with high face validity to power clinical trials. OBJECTIVES The aim of this study was to identify a set of gait measures from body-worn inertial sensors that best discriminate between people with prodromal or manifest spinocerebellar ataxia (SCA) and age-matched, healthy control subjects (HC) and determine how these measures relate to disease severity. METHODS One hundred and sixty-three people with SCA (subtypes 1, 2, 3, and 6), 42 people with prodromal SCA, and 96 HC wore 6 inertial sensors while performing a natural pace, 2-minute walk. Areas under the receiver operating characteristic curves (AUC) were compared for 25 gait measures, including standard deviations as variability, to discriminate between ataxic and normal gait. Pearson's correlation coefficient assessed the relationships between the gait measures and severity of ataxia. RESULTS Increased gait variability was the most discriminative gait feature of SCA; toe-out angle variability (AUC = 0.936; sensitivity = 0.871; specificity = 0.896) and double-support time variability (AUC = 0.932; sensitivity = 0.834; specificity = 0.865) were the most sensitive and specific measures. These variability measures were also significantly correlated with the scale for the assessment and rating of ataxia (SARA) and disease duration. The same gait measures discriminated gait of people with prodromal SCA from the gait of HC (AUC = 0.610, and 0.670, respectively). CONCLUSIONS Wearable inertial sensors provide sensitive and specific measures of excessive gait variability in both manifest and prodromal SCAs that are reliable and related to the severity of the disease, suggesting they may be useful as clinical trial performance outcome measures. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Roberto Rodriguez-Labrada
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Cuban Center for Neuroscience, Havana, Cuba
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,APDM Wearable Technologies, an ERT company, Portland, Oregon, USA
| | - James McNames
- APDM Wearable Technologies, an ERT company, Portland, Oregon, USA.,Department of Electrical and Computer Engineering, Portland State University, Portland, Oregon, USA
| | - Hannah Casey
- The University of Chicago, Chicago, Illinois, USA
| | | | | | - Jeremy D Schmahmann
- Department of Neurology, Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Cuban Academy of Sciences, La Habana, Cuba
| | - Christopher M Gomez
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,The University of Chicago, Chicago, Illinois, USA
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Song J, Shin N, Kim K, Park J. Changes in intersegmental stability during gait in patients with spastic cerebral palsy. Gait Posture 2021; 88:264-271. [PMID: 34144330 DOI: 10.1016/j.gaitpost.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dysfunction in peripheral and neural structure with spastic cerebral palsy (CP) causes impaired performance and stability of various behaviors. Recent progress of quantification methods for the stability properties, which is based on the uncontrolled manifold hypothesis, has been applied to various neurological disorders. A prior study revealed that the ability for purposeful regulation of stability properties is weakened with CP during finger and hand actions. Successive regulation of stability properties is crucial for human locomotion; therefore, it is imperative to quantify the changes in the intersegmental coordination as to the stable performance in CP individuals during gait. RESEARCH QUESTION We hypothesized that (1) Spastic CP group will show smaller step length and gait velocity with larger variability, and (2) Spastic CP group will show no changes in average stability indices for both the COM and head position stabilization, while the smaller difference between stable and unstable posture during the gait cycle. METHODS Whole-body kinematic data during walking were collected from CP and control subjects. Step length, velocity, and coefficient of variation (CV) were calculated as spatiotemporal parameters. We quantified the intersegmental stability index in time-series during gait for the stabilization of the whole-body COM and head position. RESULTS The CP subjects showed smaller step length and velocity with larger CV than the controls. However, the CP group showed a significantly less difference in the stability indices between the single- and double-limb support phases as compared to the controls for both the COM and head position stabilization. SIGNIFICANCE Present study is the first to document the quantification of changing intersegmental stability in the spastic CP during locomotion. The dysfunction of intentional modulation of stability properties in CP individuals may be a more common problem, which is not limited to a specific body effector.
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Affiliation(s)
- Junkyung Song
- Department of Physical Education, Seoul National University, Seoul, South Korea
| | - Narae Shin
- Department of Physical Education, Seoul National University, Seoul, South Korea; Institute of Sport Science, Seoul National University, Seoul, South Korea
| | - Kitae Kim
- Institute of Sport Science, Seoul National University, Seoul, South Korea; Department of Sports Science, Korea Institute of Sport Science, Seoul, South Korea
| | - Jaebum Park
- Department of Physical Education, Seoul National University, Seoul, South Korea; Institute of Sport Science, Seoul National University, Seoul, South Korea; Advanced Institute of Convergence Technology, Seoul National University, Suwon, South Korea.
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28
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The effect of levodopa on bilateral coordination and gait asymmetry in Parkinson's disease using inertial sensor. NPJ PARKINSONS DISEASE 2021; 7:42. [PMID: 33990608 PMCID: PMC8121791 DOI: 10.1038/s41531-021-00186-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/17/2021] [Indexed: 11/09/2022]
Abstract
This study aimed to evaluate the effect of levodopa on the phase coordination index (PCI) and gait asymmetry (GA) of patients with Parkinson's disease (PD) and to investigate correlations between the severity of motor symptoms and gait parameters measured using an inertial sensor. Twenty-six patients with mild-to-moderate-stage PD who were taking levodopa participated in this study. The Unified Parkinson's Disease Rating Scale part III (UPDRS III) was used to assess the severity of motor impairment. The Postural Instability and Gait Difficulty (PIGD) subscore was calculated from UPDRS III. Patients were assessed while walking a 20-m corridor in both "OFF" and "ON" levodopa medication states, and gait analysis was performed using inertial sensors. We investigated the changes in gait parameters after taking levodopa and the correlations between UPDRS III, PIGD, and gait parameters. There was a significant improvement in PCI after taking levodopa. No significant effect of levodopa on GA was found. In "OFF" state, PCI and GA were not correlated with UPDRS III and PIGD. However, in "ON" state, PCI was the only gait parameter correlating with UPDRS III, and it was also highly correlated with PIGD compared to other gait parameters. Significant improvement in bilateral-phase coordination was identified in patients with PD after taking levodopa, without significant change in gait symmetricity. Considering the high correlation with UDPRS III and PIGD in "ON" states, PCI may be a useful and quantitative parameter to measure the severity of motor symptoms in PD patients who are on medication.
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29
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Swanson CW, Richmond SB, Sharp BE, Fling BW. Middle-age people with multiple sclerosis demonstrate similar mobility characteristics to neurotypical older adults. Mult Scler Relat Disord 2021; 51:102924. [PMID: 33813095 DOI: 10.1016/j.msard.2021.102924] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical trials often report significant mobility differences between neurotypical and atypical groups, however, these analyses often do not determine which measures are capable of discriminating between groups. Additionally, indirect evidence supports the notion that some mobility impaired populations demonstrate similar mobility deficits. Thus, the current study aimed to provide a comprehensive analysis of three distinct aspects of mobility (walking, turning, and balance) to determine which variables were significantly different and were also able to discriminate between neurotypical older adults (OA) and middle-aged people with multiple sclerosis (PwMS), and between middle-aged neurotypical adults and PwMS. METHODS This study recruited 21 neurotypical OA, 19 middle-aged neurotypical adults, and 30 people with relapsing remitting MS. Participants came into the laboratory on two separate occasions to complete mobility testing while wearing wireless inertial sensors. Testing included a self-selected pace two-minute walk, a series of 180˚ and 360˚ turns, and a clinical balance test capturing a total of 99 distinct mobility characteristics. We determined significant differences for gait and turning measures through univariate analyses and a series of repeated measures analysis of variance in determining significance for balance conditions and measures. In determining discrimination between groups, the Area Under the Curve (AUC) was calculated for all individual mobility measures with a threshold of 0.80, denoting excellent discrimination. Additionally, a stepwise regression of the top five AUC producing variables was performed to determine whether a combination of variables could enhance discrimination while accounting for multicollinearity. RESULTS The results between neurotypical OA and middle-aged PwMS demonstrated significant differences for three gait and one turning variable, with no variable or combination of variables able to provide excellent discrimination between groups. Between middle-age neurotypical adults and PwMS a variety of mean and variability gait measures demonstrated significant differences between groups; however, no variable or combination of variables met discriminatory threshold. For turning, five 360˚ turn variables demonstrated significant differences and furthermore, the combination of 360˚ mean turn duration and variability of peak turn velocity were able to discriminate between groups. Finally, the majority of postural sway measures demonstrated significant group differences and the ability to discriminate between groups, particularly during more challenging balance conditions where participants stood on a compliant surface. CONCLUSION These results offer a comprehensive analysis of mobility differences and measures capable of discriminating between middle-age neurotypical adults and PwMS. Additionally, these results provide evidence that OA and middle-age PwMS display similar movement characteristics and thus a potential indicator of advanced aging from a mobility perspective.
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Affiliation(s)
- Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, Colorado, USA
| | - Sutton B Richmond
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Benjamin E Sharp
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, Colorado, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, Colorado, USA
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Ota M, Tateuchi H, Hashiguchi T, Ichihashi N. Verification of validity of gait analysis systems during treadmill walking and running using human pose tracking algorithm. Gait Posture 2021; 85:290-297. [PMID: 33636458 DOI: 10.1016/j.gaitpost.2021.02.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The human tracking algorithm called OpenPose can detect joint points and measure segment and joint angles. However, the validity of gait analysis using OpenPose has not been examined yet. RESEARCH QUESTION What is the validity of OpenPose-based gait analysis? METHODS Twenty-four healthy young people participated in this study. The participants were assessed during walking and running. Pelvic segment angles, and hip, knee, and ankle joint angles during treadmill walking and running were measured using VICON. Simultaneously, images were captured using digital cameras from the right and back sides. After processing with OpenPose, the corresponding angles were measured from the estimated joint points. To validate these estimations, linear regression analysis was performed, and intraclass correlation coefficients [ICCs (2, 1)] between the data obtained by OpenPose and VICON were calculated. Furthermore, the agreement between the data obtained by OpenPose and VICON was assessed by Bland-Altman analysis. RESULTS For most ranges of motion (ROM) in the sagittal plane, the hip, knee, and ankle joints had large coefficients of determination, without proportional biases. For most peak angles in the sagittal plane, the knee and ankle joints had large coefficients of determination without proportional biases, although the hip joint had nonsignificant coefficients of determination and proportional biases. In particular, for the hip flexion-extension ROM and peak knee flexion angle during running and the knee ROM during slow walking, the ICCs showed good to excellent agreement. However, for the parameters of the pelvis and hip joint in the frontal plane, there were nonsignificant coefficients of determination and poor ICCs with fixed and proportional biases. SIGNIFICANCE The lower limb ROM in the sagittal plane during gait can be measured by the OpenPose-based motion analysis system. The markerless systems have the advantage of being more economical and convenient than conventional methods.
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Affiliation(s)
- Megumi Ota
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dasgupta P, VanSwearingen J, Godfrey A, Redfern M, Montero-Odasso M, Sejdic E. Acceleration Gait Measures as Proxies for Motor Skill of Walking: A Narrative Review. IEEE Trans Neural Syst Rehabil Eng 2021; 29:249-261. [PMID: 33315570 PMCID: PMC7995554 DOI: 10.1109/tnsre.2020.3044260] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In adults 65 years or older, falls or other neuromotor dysfunctions are often framed as walking-related declines in motor skill; the frequent occurrence of such decline in walking-related motor skill motivates the need for an improved understanding of the motor skill of walking. Simple gait measurements, such as speed, do not provide adequate information about the quality of the body motion's translation during walking. Gait measures from accelerometers can enrich measurements of walking and motor performance. This review article will categorize the aspects of the motor skill of walking and review how trunk-acceleration gait measures during walking can be mapped to motor skill aspects, satisfying a clinical need to understand how well accelerometer measures assess gait. We will clarify how to leverage more complicated acceleration measures to make accurate motor skill decline predictions, thus furthering fall research in older adults.
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Pieruccini-Faria F, Black SE, Masellis M, Smith EE, Almeida QJ, Li KZH, Bherer L, Camicioli R, Montero-Odasso M. Gait variability across neurodegenerative and cognitive disorders: Results from the Canadian Consortium of Neurodegeneration in Aging (CCNA) and the Gait and Brain Study. Alzheimers Dement 2021; 17:1317-1328. [PMID: 33590967 PMCID: PMC8451764 DOI: 10.1002/alz.12298] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 01/01/2023]
Abstract
Introduction Gait impairment is common in neurodegenerative disorders. Specifically, gait variability—the stride‐to‐stride fluctuations in distance and time—has been associated with neurodegeneration and cognitive impairment. However, quantitative comparisons of gait impairments across the cognitive spectrum of dementias have not been systematically investigated. Methods Older adults (N = 500) with subjective cognitive impairment, Parkinson disease (PD), mild cognitive impairment (MCI), PD‐MCI, Alzheimer's disease (AD), PD‐dementia, Lewy body dementia, and frontotemporal dementia, as well cognitive normal controls, who were assessed for their gait and cognitive performance. Results Factor analyses grouped 11 quantitative gait parameters and identified four independent gait domains: rhythm, pace, variability, and postural control, for group comparisons and classification analysis. Among these domains, only high gait variability was associated with lower cognitive performance and accurately discriminated AD from other neurodegenerative and cognitive conditions. Discussion Our findings indicate that high gait variability is a marker of cognitive‐cortical dysfunction, which can help to identify Alzheimer's disease dementia.
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Affiliation(s)
- Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Department of Medicine and Division of Geriatric Medicine, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Department of Epidemiology and Biostatistics, University of Western Ontario, London, N6C 0A7, Canada
| | - Sandra E Black
- Department of Medicine and Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Department of Medicine and Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Quincy J Almeida
- Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Karen Z H Li
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Louis Bherer
- Departments of Medicine, Montreal Heart Institute and Institut Universitaire de Gériatrie de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Department of Medicine and Division of Geriatric Medicine, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Department of Epidemiology and Biostatistics, University of Western Ontario, London, N6C 0A7, Canada
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Hearing Loss Is Associated with Increased Variability in Double Support Period in the Elderly. SENSORS 2021; 21:s21010278. [PMID: 33406602 PMCID: PMC7795333 DOI: 10.3390/s21010278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 01/09/2023]
Abstract
Hearing loss is a disabling condition that increases with age and has been linked to difficulties in walking and increased risk of falls. The purpose of this study is to investigate changes in gait parameters associated with hearing loss in a group of older adults aged 60 or greater. Custom-engineered footwear was used to collect spatiotemporal gait data in an outpatient clinical setting. Multivariable linear regression was used to determine the relationship between spatiotemporal gait parameters and high and low frequency hearing thresholds of the poorer hearing ear, the left ear, and the right ear, respectively, adjusting for age, sex, race/ethnicity, and the Dizziness Handicap Inventory–Screening version score. Worsening high and low frequency hearing thresholds were associated with increased variability in double support period. Effects persisted after adjusting for the effects of age and perceived vestibular disability and were greater for increases in hearing thresholds for the right ear compared to the left ear. These findings illustrate the importance of auditory feedback for balance and coordination and may suggest a right ear advantage for the influence of auditory feedback on gait.
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Gait Analysis under Spatial Navigation Task in Elderly People-A Pilot Study. SENSORS 2021; 21:s21010270. [PMID: 33401584 PMCID: PMC7796419 DOI: 10.3390/s21010270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
A decline in the Spatial Navigation (SN) abilities has been observed in the course of healthy aging. Walking is an inseparable part of the navigation process; however, research tasks overlook this aspect in studies involving seniors. The present study was designed to overcome this limitation by recording gait parameters during natural environment navigation and to determine gait indicators that most accurately assign the participants to the proper age category. Thirteen elderly (mean age = 69.1 ± 5.4 year) and sixteen young women (mean age = 21.5 ± 2.2 year) equipped with gait sensors were asked to learn a path while walking in a real building (Learning Phase), reproduce the path (Memory Phase) and reach targets after a 30 min delay (Delayed Phase). The Receiver Operating Characteristics (ROC) analysis showed that our self-developed Gait Style Change indicator, that is, the difference in the probability of feet landing between particular SN task phases, classified the participants into either the elderly or the young group with the highest accuracy (0.91). The second most important indicator, the Task-Related (step counts in each SN task phase), achieved the accuracy discrimination of 0.83. The gait indicators, comprising single gait parameters measured while navigating, might be considered as accurately differentiating older from younger people.
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Kobsar D, Masood Z, Khan H, Khalil N, Kiwan MY, Ridd S, Tobis M. Wearable Inertial Sensors for Gait Analysis in Adults with Osteoarthritis-A Scoping Review. SENSORS 2020; 20:s20247143. [PMID: 33322187 PMCID: PMC7763184 DOI: 10.3390/s20247143] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Our objective was to conduct a scoping review which summarizes the growing body of literature using wearable inertial sensors for gait analysis in lower limb osteoarthritis. We searched six databases using predetermined search terms which highlighted the broad areas of inertial sensors, gait, and osteoarthritis. Two authors independently conducted title and abstract reviews, followed by two authors independently completing full-text screenings. Study quality was also assessed by two independent raters and data were extracted by one reviewer in areas such as study design, osteoarthritis sample, protocols, and inertial sensor outcomes. A total of 72 articles were included, which studied the gait of 2159 adults with osteoarthritis (OA) using inertial sensors. The most common location of OA studied was the knee (n = 46), followed by the hip (n = 22), and the ankle (n = 7). The back (n = 41) and the shank (n = 40) were the most common placements for inertial sensors. The three most prevalent biomechanical outcomes studied were: mean spatiotemporal parameters (n = 45), segment or joint angles (n = 33), and linear acceleration magnitudes (n = 22). Our findings demonstrate exceptional growth in this field in the last 5 years. Nevertheless, there remains a need for more longitudinal study designs, patient-specific models, free-living assessments, and a push for "Code Reuse" to maximize the unique capabilities of these devices and ultimately improve how we diagnose and treat this debilitating disease.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
- Correspondence:
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Heba Khan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Noha Khalil
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Marium Yossri Kiwan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Sarah Ridd
- Department of Psychology, Neuroscience, and Behaviour, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Matthew Tobis
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
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Using wearable sensors to characterize gait after spinal cord injury: evaluation of test-retest reliability and construct validity. Spinal Cord 2020; 59:675-683. [PMID: 33024297 DOI: 10.1038/s41393-020-00559-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Quantitative cross-sectional study. OBJECTIVES Evaluate the test-retest reliability and the construct validity of inertial measurement units (IMU) to characterize spatiotemporal gait parameters in individuals with SCI. SETTING Two SCI rehabilitation centers in Canada. METHODS Eighteen individuals with SCI participated in two evaluation sessions spaced 2 weeks apart. Fifteen able-bodied individuals were also recruited. Participants walked 20 m overground under five conditions that challenged balance to varying degrees. Five IMU were attached to the lower-extremities and the sacrum to collect the mean and the coefficient of variation of five gait parameters (gait cycle time, double-support percentage, cadence, stride length, stride velocity). Intra-class correlation coefficients (ICC) were used to evaluate the test-retest reliability. Linear mixed-effects models were used to compare the five walking conditions to evaluate known-group validity while Spearman's correlation coefficients were used to characterize the level of association between gait parameters and the Mini BESTest (MBT). RESULTS Cadence was reliable across all walking conditions. Reliability was higher for the mean (ICC = 0.55-0.98) of the parameters compared to their coefficient of variation (ICC = 0.16-0.97). Cadence collected with IMU had construct validity as their values differed across walking conditions and groups of participants. The coefficient of variation was generally better than the mean to show differences across the five walking conditions. The MBT was moderately to strongly associated with mean cadence (ρ ≥ 0.498) and its coefficient of variation (ρ ≤ -0.49) during most walking conditions. CONCLUSIONS IMU provide reliable and valid measurements of gait parameters in ambulatory individuals with SCI.
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Bahadori S, Immins T, Wainwright TW. Reliability of gait parameters in male and female healthy adults during self-paced treadmill-based walking. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims The purpose of this study was to examine the intra-rater reliability of the Gait Real-time Analysis Interactive Laboratory system during self-paced mode, in repeated gait analysis of healthy individuals. Methods A total of 10 healthy men (age: 35.4 ± 13.3 years; body mass index: 25.2 ± 4.3) and 10 healthy women (age: 41.1 ± 16.4 years; body mass index: 24.5 ± 2.6) were split into two groups according to sex. They walked on a split-belt, self-paced treadmill. Each participant completed two gait assessments separated by an average of 7 ± 3 days. Key gait kinematic, kinetic and spatial-temporal parameters were analysed. The interclass correlation coefficient, standard error of measurement and minimum detectable change were calculated to evaluate the reliability of these gait parameters. Results There was a high repeatability of spatial temporal and excellent repeatability of kinematic and kinetic parameters in both groups. Conclusions The findings suggest that the Gait Real-time Analysis Interactive Laboratory system in self-paced mode is a good instrument to evaluate gait parameters for women as well as men.
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Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
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Pieruccini-Faria F, Montero-Odasso M. Obstacle Negotiation, Gait Variability, and Risk of Falling: Results From the "Gait and Brain Study". J Gerontol A Biol Sci Med Sci 2020; 74:1422-1428. [PMID: 30380013 DOI: 10.1093/gerona/gly254] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gait variability is an early fall predictor. However, it is unknown how gait variability of older adults at high risk of falls is affected by an obstacle negotiation task. We aimed to compare gait performance between older adults with significant history of falls (i.e. fallers) and nonfallers while approaching an obstacle crossing. METHODS A total of 137 older adults without dementia were enrolled (72.7 ± 5.1 years of age; 60.5% women) from the "Gait and Brain Study." Fallers were defined as having at least one injurious fall or at least two noninjurious falls in the previous 12 months. Participants performed gait assessments under unobstructed and obstructed conditions. During the obstructed condition, participants walked and stepped over an ad hoc obstacle set at 15% of participants' height, transversally placed on a 6-meter electronic walkway. Gait speed and step-to-step variabilities were quantified from the last six steps prior to obstacle crossing. Analysis of variance models adjusted for age, sex, fear of falling, comorbidities, and unobstructed gait were used to compare gait performance of fallers and nonfallers during an obstacle approaching. RESULTS In the study, 27 older adults were identified as fallers and 110 as nonfallers. Fallers had higher step time variability and step length variability when approaching an obstacle compared with nonfallers, although groups had comparable gait performance during unobstructed walking. CONCLUSION Gait variability of older individuals at high risk of falling is more disturbed, compared with low-risk individuals, while approaching an obstacle crossing. High gait variability prior to crossing an obstacle may be a risk factor for falls.
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Affiliation(s)
- Frederico Pieruccini-Faria
- Division of Geriatric Medicine, Department of Medicine, University of Western Ontario, London.,Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, ON
| | - Manuel Montero-Odasso
- Division of Geriatric Medicine, Department of Medicine, University of Western Ontario, London.,Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, ON.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
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Herssens N, van Criekinge T, Saeys W, Truijen S, Vereeck L, van Rompaey V, Hallemans A. An investigation of the spatio-temporal parameters of gait and margins of stability throughout adulthood. J R Soc Interface 2020; 17:20200194. [PMID: 32429825 DOI: 10.1098/rsif.2020.0194] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Age-related changes in the way of walking may induce changes in dynamic stability. Therefore, the relationship between age, spatio-temporal characteristics and margins of stability was examined. One hundred and five healthy adults aged between 20 and 89 years old were analysed on spatio-temporal characteristics and margins of stability using three-dimensional motion analysis. Subjects walked barefoot over a 12-m-long walkway at their preferred walking speed. Covariance among gait characteristics was reduced using a factor analysis, identifying domains of gait. The influence of age, gender, body mass index (BMI) and leg length on domains of gait and margins of stability was investigated using linear mixed models. A stepwise linear regression identified domains of gait predicting the variance in margins of stability. Four domains of gait explaining 74.17% of the variance were identified. Age had a significant influence on the medio-lateral margin of stability and the 'variability', 'pace' and 'base of support' domain. BMI significantly influenced the medio-lateral margin of stability; gender and leg length had no influence on either of the margins of stability. The 'base of support' domain predicted 26% of the variance in the medio-lateral margin of stability. When considering the margins of stability, especially when comparing multiple groups, age, BMI and spatio-temporal parameters should be taken into account.
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Affiliation(s)
- Nolan Herssens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Wilrijk, Belgium
| | - Tamaya van Criekinge
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Wilrijk, Belgium
| | - Steven Truijen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Wilrijk, Belgium
| | - Luc Vereeck
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Wilrijk, Belgium
| | - Vincent van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Ann Hallemans
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Wilrijk, Belgium
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Kobsar D, Charlton JM, Tse CTF, Esculier JF, Graffos A, Krowchuk NM, Thatcher D, Hunt MA. Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis. J Neuroeng Rehabil 2020; 17:62. [PMID: 32393301 PMCID: PMC7216606 DOI: 10.1186/s12984-020-00685-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults. METHODS Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intraclass correlation coefficients (ICC) for validity and reliability, respectively. Alternatively, qualitative summaries of outcomes were conducted on those that could not be meta-analyzed. RESULTS A total of 82 articles, assessing the validity or reliability of over 100 outcomes, were included in this review. Seventeen biomechanical outcomes, primarily spatiotemporal parameters, were meta-analyzed. The validity and reliability of step and stride times were found to be excellent. Similarly, the validity and reliability of step and stride length, as well as swing and stance time, were found to be good to excellent. Alternatively, spatiotemporal parameter variability and symmetry displayed poor to moderate validity and reliability. IMUs were also found to display moderate reliability for the assessment of local dynamic stability during walking. The remaining biomechanical outcomes were qualitatively summarized to provide a variety of recommendations for future IMU research. CONCLUSIONS The findings of this review demonstrate the excellent validity and reliability of IMUs for mean spatiotemporal parameters during walking, but caution the use of spatiotemporal variability and symmetry metrics without strict protocol. Further, this work tentatively supports the use of IMUs for joint angle measurement and other biomechanical outcomes such as stability, regularity, and segmental accelerations. Unfortunately, the strength of these recommendations are limited based on the lack of high-quality studies for each outcome, with underpowered and/or unjustified sample sizes (sample size median 12; range: 2-95) being the primary limitation.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Francois Esculier
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,The Running Clinic, Lac Beauport, QC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Thatcher
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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Hirata K, Hattori T, Kina S, Chen Q, Ohara M, Yokota T. Striatal Dopamine Denervation Impairs Gait Automaticity in Drug‐Naïve Parkinson's Disease Patients. Mov Disord 2020; 35:1037-1045. [DOI: 10.1002/mds.28024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kosei Hirata
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Satoko Kina
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Qingmeng Chen
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Masahiro Ohara
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Takanori Yokota
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
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Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, Fraser S, Muir-Hunter S, Li KZH, Liu-Ambrose T, McIlroy W, Middleton L, Morais JA, Sakurai R, Speechley M, Vasudev A, Beauchet O, Hausdorff JM, Rosano C, Studenski S, Verghese J. Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA). J Gerontol A Biol Sci Med Sci 2020; 74:897-909. [PMID: 30101279 PMCID: PMC6521916 DOI: 10.1093/gerona/gly148] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions. Methods Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects. Results From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the “Core-battery” of tests. The expert panel also recommended a “Minimum-battery” of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B. Conclusions A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Address correspondence to: Manuel Montero-Odasso MD, PhD, AGSF, FRCPC, FGSA, Gait and Brain Lab, Parkwood Institute, University of Western Ontario and Lawson Health Research Institute, 550 Wellington Road, London, Ontario N6C 0A7, Canada. E-mail:
| | - Quincy J Almeida
- Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
- Department of Medicine, University of Montreal, Quebec, Canada
- Montreal Heart Institute, Research Centre, Quebec, Canada
| | - Amer M Burhan
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Richard Camicioli
- Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Quebec, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Susan Muir-Hunter
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada
| | - Karen Z H Li
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - José A Morais
- Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada
| | - Ryota Sakurai
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
- RUIS McGill Centre of Excellence on Aging and Chronic Disease – CEViMaC, Montréal, Quebec, Canada
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Stephanie Studenski
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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43
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Carcreff L, Gerber CN, Paraschiv-Ionescu A, De Coulon G, Newman CJ, Aminian K, Armand S. Comparison of gait characteristics between clinical and daily life settings in children with cerebral palsy. Sci Rep 2020; 10:2091. [PMID: 32034244 PMCID: PMC7005861 DOI: 10.1038/s41598-020-59002-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/16/2020] [Indexed: 11/09/2022] Open
Abstract
Gait assessments in standardized settings, as part of the clinical follow-up of children with cerebral palsy (CP), may not represent gait in daily life. This study aimed at comparing gait characteristics in laboratory and real life settings on the basis of multiple parameters in children with CP and with typical development (TD). Fifteen children with CP and 14 with TD wore 5 inertial sensors (chest, thighs and shanks) during in-laboratory gait assessments and during 3 days of daily life. Sixteen parameters belonging to 8 distinct domains were computed from the angular velocities and/or accelerations. Each parameter measured in the laboratory was compared to the same parameter measured in daily life for walking bouts defined by a travelled distance similar to the laboratory, using Wilcoxon paired tests and Spearman’s correlations. Most gait characteristics differed between both environments in both groups. Numerous high correlations were found between laboratory and daily life gait parameters for the CP group, whereas fewer correlations were found in the TD group. These results demonstrated that children with CP perform better in clinical settings. Such quantitative evidence may enhance clinicians’ understanding of the gap between capacity and performance in children with CP and improve their decision-making.
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Affiliation(s)
- Lena Carcreff
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland. .,Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, 1011, Lausanne, Switzerland. .,Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland.
| | - Corinna N Gerber
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
| | - Geraldo De Coulon
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland.,Pediatric orthopedics, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Christopher J Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
| | - Stéphane Armand
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland
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44
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Stuart S, Parrington L, Morris R, Martini DN, Fino PC, King LA. Gait measurement in chronic mild traumatic brain injury: A model approach. Hum Mov Sci 2020; 69:102557. [DOI: 10.1016/j.humov.2019.102557] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/04/2023]
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45
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Wireless battery-free body sensor networks using near-field-enabled clothing. Nat Commun 2020; 11:444. [PMID: 31974376 PMCID: PMC6978350 DOI: 10.1038/s41467-020-14311-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Networks of sensors placed on the skin can provide continuous measurement of human physiological signals for applications in clinical diagnostics, athletics and human-machine interfaces. Wireless and battery-free sensors are particularly desirable for reliable long-term monitoring, but current approaches for achieving this mode of operation rely on near-field technologies that require close proximity (at most a few centimetres) between each sensor and a wireless readout device. Here, we report near-field-enabled clothing capable of establishing wireless power and data connectivity between multiple distant points around the body to create a network of battery-free sensors interconnected by proximity to functional textile patterns. Using computer-controlled embroidery of conductive threads, we integrate clothing with near-field-responsive patterns that are completely fabric-based and free of fragile silicon components. We demonstrate the utility of the networked system for real-time, multi-node measurement of spinal posture as well as continuous sensing of temperature and gait during exercise. Though wireless near-field communication (NFC) technologies that connect wearable sensors for health monitoring have been reported, the short range of NFC readers limits sensor functionality. Here, the authors report a wireless and battery-free body sensor network with near-field-enabled clothing.
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46
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Pieruccini‐Faria F, Sarquis‐Adamson Y, Anton‐Rodrigo I, Noguerón‐García A, Bray NW, Camicioli R, Muir‐Hunter SW, Speechley M, McIlroy B, Montero‐Odasso M. Mapping Associations Between Gait Decline and Fall Risk in Mild Cognitive Impairment. J Am Geriatr Soc 2019; 68:576-584. [DOI: 10.1111/jgs.16265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Frederico Pieruccini‐Faria
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and DentistryUniversity of Western Ontario London Ontario Canada
| | - Yanina Sarquis‐Adamson
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
| | - Ivan Anton‐Rodrigo
- Department of Geriatric MedicineMatia Fundazioa, Hospital Ricardo Bermingham San Sebastian Spain
| | | | - Nick W. Bray
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Faculty of Health SciencesSchool of Kinesiology, University of Western Ontario London Ontario, Canada
| | - Richard Camicioli
- Faculty of Health Sciences, School of Physical TherapyUniversity of Western Ontario London Ontario Canada
| | - Susan W. Muir‐Hunter
- Faculty of Health Sciences, School of Physical TherapyUniversity of Western Ontario London Ontario Canada
| | - Mark Speechley
- Department of Epidemiology and BiostatisticsUniversity of Western Ontario London Ontario Canada
| | - Bill McIlroy
- Department of KinesiologyUniversity of Waterloo Waterloo Ontario Canada
| | - Manuel Montero‐Odasso
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and DentistryUniversity of Western Ontario London Ontario Canada
- Faculty of Health SciencesSchool of Kinesiology, University of Western Ontario London Ontario, Canada
- Division of Neurology, Department of MedicineUniversity of Alberta Edmonton Alberta Canada
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47
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Magnani PE, Freire Junior RC, Zanellato NFG, Genovez MB, Alvarenga IC, Abreu DCCD. The influence of aging on the spatial and temporal variables of gait during usual and fast speeds in older adults aged 60 to 102 years. Hum Mov Sci 2019; 68:102540. [DOI: 10.1016/j.humov.2019.102540] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
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48
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Ravi DK, Gwerder M, König Ignasiak N, Baumann CR, Uhl M, van Dieën JH, Taylor WR, Singh NB. Revealing the optimal thresholds for movement performance: A systematic review and meta-analysis to benchmark pathological walking behaviour. Neurosci Biobehav Rev 2019; 108:24-33. [PMID: 31639377 DOI: 10.1016/j.neubiorev.2019.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 01/29/2023]
Abstract
In order to address whether increased levels of movement output variability indicate pathological performance, we systematically reviewed and synthesized meta-analysis data on healthy and pathological motor behavior. After screening up to 24'000 reports from four databases, 85 studies were included containing 2409 patients and 2523 healthy asymptomatic controls. The optimal thresholds of variability with uncertainty boundaries (in % Coefficient of Variation ± Standard Error) were estimated in 7 parameters: stride time (2.34 ± 0.21), stride length (2.99 ± 0.37), step length (3.34 ± 0.84), swing time (2.94 ± 0.60), step time (3.35 ± 0.23), step width (15.87 ± 1.86), and dual-limb support time (6.08 ± 2.83). All spatio-temporal parameters exhibited a positive effect size (pathology led to increased variability) except step width variability (Effect Size = -0.21). By objectively benchmarking thresholds for pathological motor variability also presented through a case-study, this review provides access to movement signatures to understand neurological changes in an individual that are apparent in movement variability. The comprehensive evidence presented now qualifies stride time variability as a movement biomarker, endorsing its applicability as a viable outcome measure in clinical trials.
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Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Michelle Gwerder
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Niklas König Ignasiak
- Department of Physical Therapy, Chapman University, Rinker Health Science Campus, 9401 Jeronimo Rd, Irvine, CA, 92618, USA
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, 8091, Zürich, Switzerland
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zurich, 8091, Zürich, Switzerland
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| | - Navrag B Singh
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
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49
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Koychev I, Galna B, Zetterberg H, Lawson J, Zamboni G, Ridha BH, Rowe JB, Thomas A, Howard R, Malhotra P, Ritchie C, Lovestone S, Rochester L. Aβ42/Aβ40 and Aβ42/Aβ38 Ratios Are Associated with Measures of Gait Variability and Activities of Daily Living in Mild Alzheimer's Disease: A Pilot Study. J Alzheimers Dis 2019; 65:1377-1383. [PMID: 30198873 PMCID: PMC6218125 DOI: 10.3233/jad-180622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Gait disturbances are some of the earliest changes in dementia and their monitoring presents an opportunity for early diagnosis. The exact relationship between gait and well-established biomarkers of Alzheimer’s disease (AD) remains to be clarified. In this study we compared gait-related measures with cerebrospinal fluid (CSF) markers of AD pathology. We recruited seventeen participants with mild AD in a multi-site study and performed gait assessment as well as lumbar punctures to obtain CSF. CSF Aβ42/Aβ40 and Aβ42/Aβ38 correlated positively with measures of variability (step time and step length) in the clinic-based assessments. This was driven by a negative relationship between gait variability and Aβ40 and Aβ38 but not Aβ42.The amyloid ratios and gait variability measures were also associated with more severe functional impairment. We interpret these data as an indication that increasing amyloid production (i.e., increasing Aβ40 and Aβ38) is associated with diminishing cognitive-motor control of gait. These preliminary results suggest that the two amyloid ratios may be a marker of the earliest disturbances in the interplay between cognitive and motor control which characterize dementia.
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Affiliation(s)
- Ivan Koychev
- Department of Psychiatry, University of Oxford, UK
| | - Brook Galna
- Institute of Neuroscience / Institute for Ageing, Newcastle University, Newcastle, UK
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute, London, UK.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Giovanna Zamboni
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.,Center for Neurosciences and Neurotechnology, University of Modena and Reggio Emilia, Italy
| | - Basil H Ridha
- NIHR Biomedical Research Centre, University College London, UK
| | - James B Rowe
- Neurosciences, University of Cambridge, UK and MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Alan Thomas
- Institute of Neuroscience / Institute for Ageing, Newcastle University, Newcastle, UK
| | - Robert Howard
- Department of Molecular Neuroscience, University College London; Institute of Neurology, Queen Square, London, UK
| | | | | | | | - Lynn Rochester
- Institute of Neuroscience / Institute for Ageing, Newcastle University, Newcastle, UK
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50
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Dommes A. Street-crossing workload in young and older pedestrians. ACCIDENT; ANALYSIS AND PREVENTION 2019; 128:175-184. [PMID: 31048117 DOI: 10.1016/j.aap.2019.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
Although several studies have sought to identify both gap-acceptance difficulties with aging and gait differences, few have examined the extent to which crossing the street is physically and cognitively demanding for older pedestrians, in such a way that street crossing can be seen as a dual task. To gain insight into this issue, this study reports an experiment with 15 young (ages 19-26), 19 younger-old (ages 60-72), and 21 older-old (ages 73-82) adults. The participants carried out three tasks: (i) a simple walking task, (ii) a dual task involving walking while scanning (walking while pressing a button as soon as a visual or sound stimulus appeared), and (iii) a street-crossing task with vehicles approaching from two directions. The results indicated more street-crossing collisions in older-old than in younger-old and young participants. Longer reaction times were observed in the dual walking-scanning task for both old groups, especially for visual stimuli. Walking-speed comparisons yielded nonsignificant differences between the dual task and the street-crossing task in young participants, suggesting a correspondence in terms of demands and task priority. In contrast, old participants walked significantly faster in the street-crossing task than in the dual task, suggesting that they placed priority on walking rapidly than on scanning traffic. Finally, whereas the participants estimated the perceived workload to be greater when they were crossing the street than while simply walking or responding to the dual task, young participants gave the highest rating to the mental and physical demands, perhaps due to a lack of awareness of task demands among old participants.
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Affiliation(s)
- Aurélie Dommes
- IFSTTAR-LEPSIS, 25 allée des Marronniers, 78000 Versailles, France.
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